SMJ // March 1981, Volume 74 - Issue 3
Editorial
A MEANINGFUL RELATIONSHIP
Announcement
GENERAL ANNOUNCEMENTS
Primary Article
The Periodic Health Examination Comparison of Recommendations and Internists Performance
In this paper we bring together recommendations from three expert sources for preventive care by periodic health examination of adults. We compare these recommendations with care items considered essential for such examinations, and those actually performed by a panel of practicing internists. We found substantial differences among the expert groups…
Primary Article
Homicide in Five Southern States A Firearms Phenomenon
Homicide is a leading contributor to loss of life in the productive years. Of the 20,000 homicides yearly in the United States, the majority are committed with firearms. Because homicide rates and gun ownership are highest in the southern states, a descriptive study of 20,980 homicides occurring in five southern…
Primary Article
Diazepam Infusion in Tetanus Correlation of Drug Levels With Effect
A patient with muscle spasms and rigidity associated with tetanus was successfully treated with a continuous infusion of diazepam. This beneficial response was associated with a minimal serum diazepam concentration of 500 ng/ml. The major metabolite of diazepam, DMD, did not appear to exert substantial activity. Guidelines for dosing diazepam…
Primary Article
Fatal Lung Abscesses Review of 11 Years Experience
A review of the outcome of 440 patients hospitalized between 1967 and 1977 because of lung abscess showed that 41 died (case fatality rate = 9.3%). Major predisposing factors were present in many of the fatal and nonfatal cases. Advanced age and concomitant diseases were associated with a higher risk…
Primary Article
Blastomycosis Diagnostic Difficulties
In five cases of blastomycosis, invasive procedures were required before the diagnosis was established; these included thoracotomy in two cases and craniotomy in a third case. Radiologic signs in blastomycosis are nonspecific, and the presentations of the disease may be protean and unusual. Certain factors and radiologic appearances should alert…
Primary Article
Edwardsiella tarda Osteomyelitis in a Patient With SC Hemoglobinopathy
Edwardsiella tarda is a recently identified gram-negative organism of the family Enterobacteriaceae. Reports of human infections with E tarda have been infrequent. We review 14 cases of systemic edwardsiellosis reported in the literature, and report a case of E tarda osteomyelitis in a patient with sickle cell—hemoglobin C disease. In…
Primary Article
Clinical Assessment of Cimetidine Myelotoxicity
After case reports of alleged cimetidine-induced neutropenia, we investigated the possibility that cimetidine might produce occult bone marrow injury by a mechanism other than idiosyncratic hypersensitivity. We performed hydrocortisbne challenge tests to assess the bone marrow granulocyte reserves before, during, and after cimetidine administration. No decrease in marrow granulocyte reserves…
Primary Article
Onchocerciasis in Expatriates on the Ivory Coast
Six cases of onchocerciasis were diagnosed in expatriates working on a hydroelectric dam project in Taabo (Ivory Coast) between 1977 and 1978. Taabo is in the forest area of the Bandama River, where onchocerciasis is hyperendemic. The six patients had lived in the area from 20 months to four years….
Primary Article
Barretts Esophagus and Active Duodenal Ulcer An Important Clinical Association
A retrospective review of five patients with Barretts esophagus revealed three with an associated active duodenal ulcer. Two patients also had adenocarcinoma of the esophagus. Any-patient with prolonged gastroesophageal reflux should have careful radiologic and endoscopic evaluation of the entire upper gastrointestinal tract.
Primary Article
Observations of Esophageal Relationships in a Case of Achalasia
This study of an 85-year-old man with severe achalasia correlates postmortem findings with the medical history and clinical manifestations. Possible explanations are discussed and related to cases previously described.
Primary Article
Wick Catheter in Evaluating and Treating Compartment Syndromes
We prospectively analyzed 45 patients with suspected compartment syndromes involving 55 extremities to determine the role of the wick catheter in their management. The wick catheter technic allows the continuous monitoring of interstitial pressure and provides an objective assessment of compartment pressure. Indications for catheter use, technics for catheter preparation…
Primary Article
Antepartum Cardiotachometry for Fetal Evaluation
Results of 686 nonstress tests with fetal monitoring were analyzed and compared to neonatal outcome. The use of an antepartum cardiotachometry screening (ACS) protocol seems to have reduced the perinatal mortality and morbidity in a high-risk group of patients to that of a low-risk group who did not undergo ACS
Primary Article
Transsphenoidal Hypophysectomy in Disseminated Breast Cancer
Sixty patients with metastatic breast cancer had transsphenoidal hypophysectomy at Emory University Hospital. Median survival for the entire group was ten months. Survival was increased (longer than 14 months) in good responders as compared to nonresponders (three months). Pain was significantly relieved in the majority of those patients who had…
Primary Article
Prostaglandin Suppression inability to Correct Severe Idiopathic Orthostatic Hypotension
A 70-year-old man with classic severe idiopathic orthostatic hypotension received three different indomethacin dose regimens. Baseline urinary prostaglandin concentrations were modestly elevated. Although indomethacin greatly lowered prostaglandin production, no sustained improvement in blood pressure or symptoms occurred. It is proposed that the interindividual variations in vascular reactivity and circulating prostaglandin…
Primary Article
Three Simple Solutions for Renal Flush and Preservation
The harvesting of kidneys at small hospitals where standard flush solutions are not available has led to the use of several flush solutions that can be made from readily available materials. Mongrel dogs (15) had bilateral nephrectomy after receiving intravenously a mixture of Ringers lactate, furosemide (Lasix), mannitol, and chlorpromazine…
Primary Article
Streptococcal Pharyngitis in Infants A Reappraisal of Its Prevalence
The prevalence of group A streptococcal pharyngitis in children under 3 years of age was determined by retrospective review of the results of throat cultures taken from children seen in a middle-class, suburban, private pediatric practice. Of 2,200 throat cultures obtained, 7% (149) were from children in this age group,…
Primary Article
Establishing a Low Back School
We present a plan for establishing a facility for conservative treatment of patients with low back pain. This system is based on a concept of one therapist instructing one patient in certain anatomy and body mechanics appropriate to his needs. Audiovisual programs are used in this part of the program….
Primary Article
Comparative Costs of Diagnosis and Treatment in Acute Pharyngitis
Throat cultures from 86 consecutive patients with a clinical diagnosis of pharyngitis yielded 23 (27%) that were positive for β-hemolytic streptococci. The cost of using oral antibiotics and of obtaining and processing throat cultures was determined. Using these data the following two theoretic strategies were cost accounted: Strategy A: Empiric…
Review Article
Gram-Negative Bacteremic Shock Pathophysiology, Clinical Features, and Treatment
life-threatening, gram-negative-rod bacteremia often complicates modern surgical procedures. The development of shock in association with gram-negative bacteremia represents a grave complication. The pathophysiology and clinical features of gram-negative bacteremic shock are reviewed, and contemporary forms of therapy are evaluated.
Current Concepts
Treatment of Small Cell Lung Cancer
The prognosis for patients with small cell lung cancer has improved over the past ten years from a median survival of 2.5 months to 8 to 10 months for patients with extensive metastatic disease and 12 to 16 months for patients with limited disease. This progress has been primarily through…
Current Concepts
Methylphenidate in Depression and States of Apathy
Methylphenidate hydrochloride (Ritalin) has been used to treat both depression and apathy. Although it can be useful for apathy, there is little reason to prefer it over a tricyclic antidepressant in the treatment of depression. Side effects and drug interactions are generally not limiting, and methylphenidate is tentatively recommended for…
Article
On Making Clinical Research Count
Principles of sound research design are inconstantly applied to scientific investigations. Quality research depends on good study design. Many research groups appear to favor quick publishable experiments over more rigorously controlled ones. Clinicians seem inadequately prepared to critically evaluate, journal articles for quality of research, clinical relevance, and comparability of…
Medical Education
A Very Short Essay on Contemporary Medical Education
“The tragedy of our time is that too often change is obstructed at the highest level of academia, not for intellectual reasons but because some fear loss of control, exposure of personal ignorance in the field of scholarship, or change of personal status.” S. B. Day, New England Journal of…
